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Human Resources for Health
Open Access
Review
The global pharmacy workforce: a systematic review of the
literature
Nicola Hawthorne and Claire Anderson*
Address: Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
Email: Nicola Hawthorne - ; Claire Anderson*
* Corresponding author
Abstract
The importance of health workforce provision has gained significance and is now considered one of the
most pressing issues worldwide, across all health professions. Against this background, the objectives of
the work presented here were to systematically explore and identify contemporary issues surrounding
expansion of the global pharmacy workforce in order to assist the International Pharmaceutical Federation
working group on the workforce.
International peer and non-peer-reviewed literature published between January 1998 and February 2008
was analysed. Articles were collated by performing searches of appropriate databases and reference lists
of relevant articles; in addition, key informants were contacted. Information that met specific quality
standards and pertained to the pharmacy workforce was extracted to matrices and assigned an evidence
grade.
Sixty-nine papers were identified for inclusion (48 peer reviewed and 21 non-peer-reviewed). Evaluation
of evidence revealed the global pharmacy workforce to be composed of increasing numbers of females
who were working fewer hours; this decreased their overall full-time equivalent contribution to the
workforce, compared to male pharmacists. Distribution of pharmacists was uneven with respect to
location (urban/rural, less-developed/more-developed countries) and work sector (private/public).
Graduates showed a preference for completing pre-registration training near where they studied as an
undergraduate; this was of considerable importance to rural areas. Increases in the number of pharmacy
student enrolments and pharmacy schools occurred alongside an expansion in the number and roles of

for expansion of the international health workforce in
order to meet the health-related Millennium Develop-
ment Goals. The Global Health Workforce Alliance was
established to accelerate progress towards these goals by
identifying and implementing solutions to the shortages
[2]. The international shortage of health care profession-
als exists in different severities and has different root
causes, depending on the particular health profession and
the country of origin. Health care priorities therefore
change between countries: a universal health system
would invariably not provide the required health care effi-
ciently to all those who need it. The Global pharmacy work-
force and migration report was the first of its kind to
investigate specific workforce issues affecting the interna-
tional pharmacy profession as a whole [3].
This review focuses upon the issues facing the expansion
of the global pharmacy workforce; by gathering together
past and present literature, it provides a platform for dis-
cussion, planning and action to enable the management
of current problems and the foresight of future challenges
worldwide. The main objectives of this report are to sys-
tematically identify and review the contemporary issues
surrounding the global pharmacy workforce and, more
specifically, to explore the published methods used to
expand the workforce. The review was produced for the
International Pharmaceutical Federation's working group
on the pharmacy workforce.
Methods
Relevant peer-reviewed and non-peer-reviewed interna-
tional literature was initially identified via searches on

Additional files 1 and 2, which were independently
checked by the second author). The evidence that did not
meet all the Evidence Base 2000 standards was clearly
annotated in the matrices.
Results
In total, 69 papers were identified for inclusion in the
review: 48 peer-reviewed papers and 21 non-peer-
reviewed reports. Most of the evidence gathered was in the
B3 category (individual, well-designed, non-experimental
studies; well-designed qualitative studies; and well-
designed analytical studies, including secondary analysis),
which was also the highest evidence grade achieved in this
review. The papers and reports revealed several key areas
important in workforce planning and expansion; these are
detailed below.
Demographics
The proportion of females within the pharmacy workforce
was found to either predominate, as observed in the
United Kingdom [6], Canada [7], New Zealand [8] and
Ireland [9], or be increasing, as seen in the United States
between 2000 and 2004 [10,11]. The age of practising
pharmacists was another important demographic issue
presented in the national pharmacist workforce data from
these countries. In general, the largest proportion of phar-
macists was aged between 30 and 45 years [6,11-16] and
the majority of male pharmacists tended to be older than
the females; this was the case in New Zealand [8], the
United Kingdom [6], the United States [11], Ireland [9],
Australia [14] and Canada [7]. Generally male pharma-
cists predominated above the age of 50.

trends [22]. Graduates also showed a preference for com-
pleting pre-registration training near where they studied
as an undergraduate [27,28]; this was of considerable
importance when planning recruitment to rural areas in
Australia [23].
Pharmacy technicians
The relative importance of pharmacy technicians within
the contemporary pharmacy workforce has been ampli-
fied, largely as a reaction to pharmacist shortages. As such,
their numbers and responsibilities have been increased
[29-31]. There was also found to be increased interna-
tional awareness and support for the certification, registra-
tion and regulation of pharmacy technicians, and
accreditation of the relevant training courses [32-34].
Feminization
The aforementioned increased proportion of female phar-
macists in many countries brought to light specific issues
surrounding their work patterns, particularly workforce
participation. The prevalence of part-time work among
female pharmacists was found to be much greater than
that of their male counterparts in several countries
[35,36], and as a result the full-time equivalent contribu-
tion of females was lower than that of males [36]. Females
were found to be overrepresented in the hospital sector
[11,9,20,35] and underrepresented in higher-status roles
such as management in the United States [11] and the
United Kingdom [35]. The number of female pharmacy
students graduating was also noted to have increased, thus
giving weight to the fact that female workforce issues will
become increasingly important in the future. Reports of

mon factors increasing demand for pharmacists were
increased feminization, increased clinical governance
measures through continually reviewing and improving
the quality of patient care, increased numbers of prescrip-
tions and increased complexity of medication therapy.
The most common factors mitigating demand for phar-
macists included increased use of technology, expansion
in the numbers and roles of pharmacy technicians and
increased numbers of pharmacy graduates [9,20,15,21,
39-41].
Discussion
Most of the papers identified for inclusion were judged to
be of sound methodological quality and each added value
to understanding the factors surrounding the expansion
of the pharmacy workforce. The issues surrounding plan-
ning and expansion of the pharmacy workforce elucidated
from the literature will be discussed in relation to recruit-
ment, retention and attrition.
Human Resources for Health 2009, 7:48 />Page 4 of 8
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Recruitment
There are four relatively distinct areas of recruitment, as
seen in Figure 1, which may be relied upon as routes to
expand the pharmacy workforce: undergraduate, post-
graduate, re-entry and foreign pharmacy graduates. The
first of these, undergraduate recruitment, is the only proc-
ess that will lead to expansion of the overall number of
qualified pharmacists. The literature suggested that the
main methods used to increase the number of qualified
pharmacists was to expand the number of students

study pharmacy or choose not to study pharmacy remain
unknown.
There was a lack of pharmacy students choosing to under-
take postgraduate pharmacy education. As academics are
usually required to hold a postgraduate degree, this may
worsen the pharmacy faculty shortages identified in both
the United Kingdom and United States literature. A
decline in the pharmacist-to-student ratio or a reduced
rate of expansion may result if more pharmacist faculty
were not recruited.
Another valuable area for pharmacy recruitment is the
current inactive or part-time workforce. However, the lit-
erature indicates that the capacity for increasing the partic-
ipation of this proportion of the workforce is minimal,
either because of the high proportion of female pharma-
cists with family responsibilities, the high desirability of
career breaks and part-time hours or the increasingly early
age of (phased) retirement.
The final route of increasing the size of one particular
country's pharmacy workforce is to recruit from another
country's pool of pharmacy graduates, which can be
inherently controversial. The increasing migratory flow of
the health care workforce was of particular concern in
developing countries, as the majority of migrating phar-
macists moved to more-developed countries. While this
was seen to benefit the individual for a variety of reasons,
when emigration occurred disproportionately it severely
hampered the provision of adequate health care to the
home nation. Nevertheless, despite the human resource
crisis in developing countries the opinion acknowledged

oped countries. While this produced highly competent
individuals, it did not necessarily prepare them for the
realities of a career in their own country, thus disillusion-
ment and frustration may result in increased emigration
to more-developed countries, facilitated by the similarity
of the degree course. In order to model the demands for
pharmacists, it is very important to define needs-based
roles for all cadres in the pharmacy workforce in any par-
ticular country. In addition, evolving, new and emerging
technologies and innovative practice models and their
impact on the workforce must be described for particular
country and health systems.
Training and career advancement were also predominant
in the literature, especially surrounding the retention of
female pharmacists and pharmacy technicians. Female
pharmacists, although making up the majority of the
workforce, were underrepresented in management posi-
tions, which was shown to be a result of their personal
choices influenced by family responsibilities in the United
Kingdom [42]. In terms of the pharmacy technician work-
force, the lack of a "career ladder" or opportunities for
career progression was the most frequent cause of dissat-
isfaction.
While wider roles were generally welcomed by pharma-
cists as a chance to make use of a greater breadth of their
training, it may also be prudent to mention the potential
of role overload, which may result due to high expecta-
tions for service delivery, unless sufficient resources and
staffing occur simultaneously or a shifting of roles and
responsibilities occurs.

normal work, they reduce the capacity of the workforce to
expand, as substitutes will be required to fill the temporar-
ily vacant positions. This factor is likely to grow in signif-
icance with the sustained emphasis on continuing
professional development, continuing education and risk
management measures.
Factors affecting the loss of participation in the pharmacy
workforce that may be either temporary or permanent
were classified as part-time working and migration. The
increasing trend of part-time working was largely due to
the increased proportion of female pharmacists, but it was
noted in the United States that the number of male phar-
Factors affecting pharmacist retentionFigure 2
Factors affecting pharmacist retention.
Workload
Training
Policies
Roles &
responsibilities
Working
conditions
Job satisfaction
Retention
Forms of attrition in the pharmacy workforceFigure 3
Forms of attrition in the pharmacy workforce.
Temporar
y
/
permanent
Permanent

education courses is then questionable because of the lack
of capacity to integrate new knowledge and skills into the
workplace. These circumstances accelerate the move from
the public sector to the private sector and to emigration.
Permanent loss from the workforce – true attrition – was
attributed to changing employment to a field outside
pharmacy, retirement or death. Not much was known
about the numbers of qualified pharmacists working out-
side pharmacy, as unless they remain registered there is no
way of tracking them. However, a factor increasing the
demand for pharmacists was the movement of pharma-
cists into non-traditional areas of work. The identification
of this trend clearly meant that pharmacists involved in
these fields remained registered. Nevertheless, if this set of
circumstances changes, leakage of pharmacists to "other"
employment sectors may go unnoticed.
Retirement can also only be estimated, as retired, inactive
pharmacists do not legally have to remain registered.
However, those who do and are over the state pension age
have provided very interesting information about the
pharmacy workforce. A development of concern was that
male pharmacists were generally predominant in the
workforce by a considerable margin after the age of 50;
considering that male pharmacists in the overall work-
force were in the minority, it appears that female pharma-
cists leave the profession much younger than their male
counterparts. Despite this, the majority of pharmacists
were found to be aged between 30 and 45 years. There-
fore, as long as adequate numbers of newly qualified
pharmacists and pharmacy technicians enter the work-

sioned by the International Pharmaceutical Federation,
the second edition of which is currently being produced.
Research implications
Most of the evidence included in this review is derived
from surveys and is rated at a relatively low level. Future
prospective and comparative research might use observa-
tional methodologies for certain aspects such as graduate
trends, job satisfaction and the impact of pharmacy tech-
nicians. Further research into why males are increasingly
choosing not to study pharmacy and a more coordinated
monitoring of the pharmacy workforce worldwide (par-
ticularly in developing countries) are needed. Also,
research into why pharmacy students are increasingly not
pursuing postgraduate education and what measures can
be taken to encourage careers in academia should be
undertaken.
Human Resources for Health 2009, 7:48 />Page 7 of 8
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Conclusion
This review adds significantly to the current understand-
ing of the international pharmacy workforce by bringing
together and evaluating the relevant literature from
around the world. To maintain and expand the future
pharmacy workforce, increases in recruitment and reten-
tion will be essential, as will decreases in attrition where
possible. However, scaling up the global pharmacy work-
force is a complex, multifactorial responsibility that
requires coordinated action. The repercussions of any
changes made to the pharmacy workforce need to be con-
sidered carefully and optimal use of the current workforce

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Additional file 1
Table 1. Record of peer-reviewed evidence. Annotated references.
Click here for file
[ />4491-7-48-S1.doc]
Additional file 2
Table 2. Record of non-peer reviewed evidence. Annotated references.
Click here for file
[ />4491-7-48-S2.doc]
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